Single-Center Experience of Robot-Assisted Nephrectomy and Venous Tumor Thrombectomy: Indications, Surgical Strategies, and Long-Term Outcomes

<b><i>Purpose:</i></b> To introduce the indications and surgical strategies of robot-assisted nephrectomy and venous tumor thrombectomy (RA-N-VTT) and to assess the long-term outcomes in a high-volume, single-center setting. <b><i>Materials and Methods:</i></b> We retrospectively enrolled 309 patients with renal tumors and venous tumor thrombus who underwent a robotic procedure in our center between June 2013 and December 2023. To better define the indications and surgical strategies for RA-N-VTT, we proposed the Chinese People's Liberation Army General Hospital (PLAGH) classification system, incorporating three modifications to the Mayo Clinic classification system. Specifically, thrombus within the left renal vein was divided into levels 0a and 0b based on the landmark of superior mesenteric artery. Retrohepatic inferior vena cava thrombus was reclassified using the first and second portal hepatis as landmarks. In addition, level IV thrombus was subclassified into levels IVa and IVb, depending on whether it entered the atrium. Long-term perioperative surgical and survival outcomes were analyzed. <b><i>Results:</i></b> All operations were effectively completed, except for six patients converted to open procedure. There were significant differences in perioperative outcomes among patients with different PLAGH levels of thrombus (<i>p</i> < 0.001). With a median follow-up of 47.8 months, the median overall survival (OS) and progress-free survival of all patients were 75.4 and 44.7 months, respectively. Multivariable analysis identified that distant metastasis and tumor grade were independent risk factors for OS, as well as PLAGH classification (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> Our results indicated that RA-N-VTT is safe and feasible. The PLAGH classification system effectively guides robotic surgical planning and provides acceptable surgical and survival outcomes in selected patients.